Induction of Ventricular Tachycardia by Pacemaker Programming

Abstract

The induction of ventricular tachycardia or ventricular fibrillation by competitive pacing, especially in the setting of acute myocardial ischemia, is well known. A case of ventricular tachycardia induced by a multiprogrammable unipolar cathodal ventricular pacemaker is reported. The arrhythmia was caused by reprogramming, which necessitates a short switch to fixed rate pacing in this model (Spectrax 5985 SX). This potential hazard is not well established in patients with unipolar pacemakers. The use of the magnet as one of the preconditions for reprogramming should be avoided in future pacemakers.

Evaluation of Cumulative Effects of MR Imaging on Pacemaker Systems at 1.5 Tesla

“…It should be noted that the fact that no clinically cumulative effects on PCT, LI, and BV due to multiple MRI exams performed in a given PM patient were observed in this study does not allow the conclusion that MRI‐safe PM systems do not need to be developed, because several other MRI system–PM system interactions may occur: (1) Reed switch: It has been demonstrated previously that the reed switch closes only in about 50% of all orientations in the MRI environment 25 . Closure of the reed switch may lead to asynchronous stimulation with the risk for competitive rhythms (intrinsic heart rhythm vs PM stimulation), which may lead to induction of malignant ventricular arrhythmia 26 . (2) An electrical reset with subsequent reprogramming of the PM's default factory settings, mostly VVI, can occur 5 .…”

“…Especially, MRI sequences with a high SAR and coverage of the chest and thus the PM system (such as cardiac MRI examinations) represent a perilous combination. (4) The gradient fields used for MR imaging may lead to induction of voltages in the PM leads, 28 which can lead to asynchronous stimulation with a risk for induction of ventricular arrhythmia 26,29,30 . These safety concerns must be addressed in the future when developing MRI sage PM systems.…”

Pacing Threshold Testing Induced Ventricular Fibrillation Following Acute Rate Control of Atrial Fibrillation

“…A concern initially with magnet testing of pacemakers and asynchronous ventricular pacing was the potential occurrence of VF due to R‐on‐T‐wave occurrence. However, initiation of VF with pacing on T‐wave is a very rare event, and the few reported cases have occurred in the setting of ischemia or structurally abnormal ventricles, and usually with temporary pacemakers 2–9 . We present a unique case of VF induced during routine ventricular pacing threshold testing of a permanent pacemaker in a patient without structural heart disease.…”

“…However, initiation of VF with pacing on T-wave is a very rare event, and the few reported cases have occurred in the setting of ischemia or structurally abnormal ventricles, and usually with temporary pacemakers. [2][3][4][5][6][7][8][9] We present a unique case of VF induced during routine ventricular pacing threshold testing of a permanent pacemaker in a patient without structural heart disease. This manuscript was processed by a guest editor.…”

Prevalence, circumstances, mechanisms, and risk stratification of sudden cardiac death in unipolar single-chamber ventricular pacing.

“…[29][30][31][32]35 Because any pacemaker-related pacing deficits or fatal initiation or aggravation of ventricular tachyarrhythmias reflect potentially preventable mortality, data on the mode and mechanisms of death in pacemaker patients are most important.…”